Atorvastatin Lowers Cholesterol, But Does Not Prevent Cardiac Events in Diabetic

Although atorvastatin therapy led to a significant reduction in mean LDL cholesterol level in patients with type 2 diabetes, there was no significant difference from placebo in cardiac events, such as cardiovascular death and myocardial infarction (MI). However, lead investigator Dr. Robert H. Knopp stated that "the great majority of persons with type 2 diabetes can expect benefit from a statin. One can see that trend in persons with existing coronary disease and in those (with) myocardial infarction."
Dr. Knopp of the Harborview Medical Center, Seattle and colleagues examined the difference in outcome over 4 years in more than 2400 diabetic patients, with LDL cholesterol levels of 140 mg/dL or less, who were randomized to 10 mg daily of atorvastatin or placebo.

Overall, in the atorvastatin group, 13.7% reached the composite primary end point, which included death, MI, stroke and need for coronary bypass or angina requiring hospitalization. The corresponding proportion in the placebo group was 15%.
In the subgroup of patients who had not had a prior MI or interventional procedure, just under 11% of the atorvastatin and placebo patients reached a primary end point.

Nevertheless, although risk reductions did not reach significance, there was a 27% reduction in fatal and non-fatal MI in atorvastatin patients.

"Persons at low risk from conventional risk factors," continued Dr. Knopp, "seemed to have little benefit, and in this case treatment options should focus aggressively on the individual risk factors, which may differ from patient to patient."
"Until there is further confirmation," he concluded, "the National Cholesterol Education Program LDL goal of less than 100 mg/dL remains a reasonable guideline for persons with type 2 diabetes."

Diabetes Care 2006;29:1478-1475.

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